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This article discusses the differences in drug prices between Canada and the United States, focusing on Canada's price controls and their impact on healthcare. It explores the consequences of these price differences, including the slower uptake of new drugs in Canada and the potential effects on public health. Additionally, the article examines factors that contribute to drug unavailability in Canada compared to the US. Overall, it highlights the effectiveness of Canada's approach in maintaining affordable healthcare without significantly impacting company profits.
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Controlling Drug Prices: What Canada Does Joel Lexchin MD School of Health Policy & Management York University
Outline • Price increases in Canada versus U.S. • Canadian price controls • Other differences between Canada and the U.S. • What are the consequences for Canada
Escalation in Spending U.S. and Canada, Adjusted for Inflation U.S. Canada
What Price Differences Matter: Generics vs. Brand-name Most prescriptions are filled with generics. Most of the money is spent on brand- name single source products. Health Affairs 2004;W3: 521.
U.S. Prices Compared With Other Countries Patented Medicine Prices Review Board. Annual report 2004
What’s Going On? • Why has the rate of increase in spending in Canada levelled off? • Why has the rate of increase in spending in the U.S. continued to escalate? • What are the differences between the two countries?
Control Over Prices in Canada • Patented Medicine Prices Review Board (PMPRB) • Provincial controls
Current Canadian PMPRB Rules - New Drugs Yes No No Yes Median IPC TCC TCC RR Test TCC Highest IPC Highest IPC TCC RR = relative relationship IPC = international price comparison TCC = therapeutic class comparison Highest IPC
PMPRB Regulations on Rate of Rise in Prices • Compares average transaction price of drug product with CPI adjusted price of drug product • Based on 3 year cumulative change in CPI with one year increases capped to 1.5 times annual inflation
Not Just Savings on Ingredient Costs • Administrative costs in private plans 8% versus 2% in large public plans
Overall Effect of Canadian Regulations on Prices Year-over-year changes in the PMPI (Patented Medicine Price Index) = change in transaction prices of patented drug products PMPRB Annual Report 2003
Other Differences Between Canada and the United States • No DTCA in Canada • US lacks monopsony buying power • Faster uptake of newer, more expensive drugs in U.S.
No Large Public Buyer OECD, 2004
Faster Uptake of Newer Drugs in the U.S. Canadian per capita consumption of new medicines(drugs launched in 2 most recent years) relative to the U.S., 1999 Danzon et al. Health Affairs, 2003
Are Canadians Dying in the Streets? OECD, 2004
Do Companies Keep Drugs Off the Market? • New drugs evaluated by Medical Letter May 2003-June 2004: • 40 • Available in U.S. but not in Canada: • 32 (8 now in Canada as of 24 Oct. 2004) • Number of unavailable drugs with major therapeutic advantages: • 1 to 3
Why Are Some Drugs Unavailable? • Low Canadian prices? • Longer Canadian approval times? • Smaller Canadian market? • Internal company priorities about when to market drugs in different countries?
Conclusions • Canadian prices are lower • Price controls • No DTCA • Slower uptake of newer, more expensive drugs • Consequences • Canadians healthier than Americans • No significant effect on new drug introduction • Company profits remain healthy